Return-to-Work and Clinical Outcomes After Anterior Latissimus Dorsi and Teres Major Tendon Transfer for Irreparable Subscapularis Tears

BACKGROUND: Irreparable subscapularis tears represent a significant clinical challenge, especially in active patients aiming to preserve shoulder function. Anterior latissimus dorsi and teres major (LDTM) tendon transfer has been proposed to restore internal rotation and anterior shoulder stability; however, data on return-to-work (RTW) outcomes remain limited. PURPOSE/HYPOTHESIS: The study aimed to evaluate clinical outcomes and RTW rates after anterior LDTM transfer in patients with irreparable subscapularis tears, with the hypothesis that the procedure would provide favorable clinical results and a high RTW rate. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review was conducted on patients who underwent LDTM transfer for irreparable subscapularis tears, with or without concomitant supraspinatus involvement. Inclusion criteria were irreparable subscapularis tears with medial tendon retraction and grade 3 or 4 fatty infiltration, without advanced glenohumeral arthritis. Exclusion criteria included prior bone surgery, incomplete follow-up, or loss to follow-up. Clinical assessment included patient-reported outcome measures, such as visual analog scale, American Shoulder and Elbow Surgeons form, Constant score, and Single Assessment Numeric Evaluation, as well as range of motion and strength. Tendon integrity was evaluated via magnetic resonance imaging, and RTW was assessed using structured questionnaires. Multivariable logistic regression was performed to identify factors influencing RTW. RESULTS: Of 215 patients, 189 were included after exclusions (126 male, 63 female; mean ± SD age, 64.4 ± 6.7 years; follow-up, 43.4 ± 17.1 months). Overall, 91.0% returned to work (58.2% complete, 32.8% partial), with lighter work groups achieving earlier and higher return rates. Clinical outcomes improved significantly across the cohort, including visual analog scale (4.9 ± 1.1 to 1.9 ± 1.2), American Shoulder and Elbow Surgeons form (49.4 ± 10.0 to 72.9 ± 14.0), Constant score (49.1 ± 6.0 to 65.8 ± 9.9), and Single Assessment Numeric Evaluation (48.7 ± 9.4 to 73.8 ± 13.9), as well as range of motion and strength. No significant differences were observed among work intensity groups. Tendon integrity and occupational work intensity were the strongest predictors of successful RTW. CONCLUSION: Anterior LDTM transfer is a reliable and effective treatment for patients with irreparable subscapularis tears, resulting in favorable clinical outcomes and high RTW rates. Overall, 91.0% of patients returned to work (58.2% complete, 32.8% partial) at a mean 5.4 ± 1.5 months across all work levels. Lighter occupational demands and intact tendon integrity were strong predictors of successful RTW.